A Study on the Effects of Argentine
Tango as a Form of Partnered
Dance for those with Parkinson
Disease and the Healthy Elderly
Madeleine E. Hackney
1,5
Svetlana Kantorovich
2
and
Gammon M. Earhart
1,3,4
Falls are the leading cause of injury deaths in older adults (Murphy
2000), and they can lead to fear of falling, reduced quality of life,
withdrawal from activities, and injury. Changes in joint ranges of
motion, strength, sensory processing, and sensorimotor integration all
contribute to reduced balance stability with increasing age and
these changes are paralleled in those with Parkinson Disease (PD).
Interventions, such as traditional exercises tailored specifically for
seniors and/or individuals with PD, have addressed balance and gait
difficulties in an attempt to reduce fall rates with mixed, undocu-
mented results. Argentine tango dancing has recently emerged as a
1
Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO,
63108, USA.
2
Department of Biology, Washington University in St. Louis, St. Louis, MO, 63105, USA.
3
Department of Anatomy and Neurobiology, Washington University School of Medicine,
St. Louis, MO, 63108, USA.
4
Department of Neurology, Washington University School of Medicine, St. Louis, MO,

the healthy elderly and those with PD and that tango may convey
benefits not obtained with a more traditional exercise program.
KEY WORDS: Tango; Parkinson disease; Balance.
Introduction
F
alls are the leading cause of injury deaths in older adults (Murphy
2000). Approximately one third of individuals 65 and older living in
the community will fall at least once in the span of a year (Hornbrook
et al. 1994; Hausdorff et al. 2001; CDC 2004). Falls can lead to fear of
falling, reduced quality of life, withdrawal from activities, and injury. In
2003, more than 1.8 million seniors were treated in emergency depart-
ments for fall-related injuries and 421,000 were hospitalized. The cost of
fall injuries is expected to reach $43.8 billion by the year 2020 (CDC
2004). Declines in gait, balance and cognitive function with aging are
major contributors to falling (Rubenstein and Josephson 2002). These
difficulties are even more pronounced in individuals with idiopathic
Parkinson Disease (PD), a progressive neurodegenerative condition that
affects approximately one million older adults in the United States.
Many individuals with PD experience a reduction in mobility as a result
of gait and balance difficulties. A 6-month prospective study found that
roughly 60% of people with PD experienced at least one fall (Bloem et al.
2001a, b). Among those who fall, 10% will experience serious injury such
as hip fracture or head trauma (Sterling et al. 2001).
110 M. E. Hackney et al.
Changes in joint ranges of motion, strength, sensory processing, and
sensorimotor integration all contribute to reduced balance stability with
increasing age (Rogers and Mille 2003). Gait changes associated with
aging include decreased gait speed, decreased stride length, increased
double support time, and increased width of the base of support (Woo
et al. 1995; Dobbs et al. 1993; Elble et al. 1991). These changes are more

Several interventions have attempted to reduce fall rates by
addressing balance and gait difficulties. One common approach is tra-
ditional exercises tailored specifically for seniors and/or individuals with
PD (e.g., Fit ‘N Fun (Braford 1996), Parkinson Disease & the Art of
Moving (Argue 2000)). Although several commercial exercise programs
are available and claim to be beneficial, none have been rigorously
investigated to evaluate their effects on functional mobility. One goal of
this study was to provide baseline information about the effectiveness of
111Dance for those with Parkinson Disease
a traditional strength/flexibility exercise regimen based upon the Fit ‘N
Fun (Braford 1996) program.
Though traditional exercise programs have been touted by many,
emerging evidence suggests that dance may be effective at reducing the
mobility deficits associated with aging. Dance therapist, Cynthia Berrol
defines dance as ‘‘a kinesthetic form that expresses and objectifies hu-
man emotion and experience through ordered sequences of moving
rhythmic patterns’’. As a dance/movement therapist, she believes
movement can be used to therapeutically improve the physical function
of the individual (Berrol 1990). Dance can be used to augment the
movement strategies of the individual (Berrol 1990; Westbrook and
McKibben 1989) and has been recommended for elderly people to in-
crease or maintain their range of motion (Pratt 2004). Dance therapy
has also been used as a successful therapeutic intervention for indi-
viduals with PD. People with PD who were encouraged to explore
alternative movement strategies through dance demonstrated gains in
neurological status and movement initiation (Westbrook and McKibben
1989). Additionally, dance appears to be an appropriate and pleasurable
therapeutic activity for the elderly, in terms of its benefits to physical,
mental and emotional states (Kudlacek et al. 1997). However, there is
little research to date that documents this phenomenon, and it is

prove the motor ability of our participants with PD who have difficulty
initiating gait, difficulty turning, and may experience freezing when
moving in close quarters.
Methods
Subjects
We recruited 19 subjects with PD and 19 age- and gender-matched
controls. All subjects were at least 55 years of age. All control subjects
met the following inclusion criteria: (1) normal central and peripheral
neurological function, (2) vision corrected to 20/40 or better, (3) able to
stand independently for at least 30 min and walk independently for
10 feet, (4) no history of vestibular dysfunction, and (5) MMSE score of
>25. Exclusionary criteria included: (1) serious medical problem, (2) use
of neuroleptic or other dopamine-blocking drug, (3) use of drug that
might affect balance, like a benzodiazepine, (4) evidence of abnormality
on brain imaging (previously done for clinical evaluations—not part of
this research), (5) history or evidence of other neurological deficit or (6)
history or evidence of orthopedic, muscular, or psychological problem
that could influence ability to participate in the study.
Subjects with PD were recruited from the Washington University
School of Medicine’s Movement Disorders Center and from the commu-
nity. Subjects with PD met all of the inclusion criteria for controls except
for their neurological diagnosis and use of medications for PD. PD
diagnostic criteria include those used for clinically defined ‘‘definite PD’’,
as previously outlined by Racette et al. (1999) based upon established
criteria (Calne et al. 1992; Hughes et al. 1992). Each must have had clear
benefit from PD medications and meet the above inclusionary and
exclusionary criteria.
Research Design
Subjects were randomly assigned to one of two groups: tango or tradi-
tional exercise. Nine people with PD and nine controls were assigned to

features of the program on a Likert scale. They also completed a music
questionnaire to determine how music affected their experience in the
program.
Tango Classes
Twenty hour-long progressive tango sessions were completed within
13 weeks. These lessons included postural stretches, balance exercises,
tango-style walking, embellishment footwork games, and rhythmical
experimentation, both with and without a partner.
During warm-up, the class typically began holding hands in a circle.
Imagery was suggested to the participants, such as ‘‘clouds beneath their
114 M. E. Hackney et al.
arms’’ so they could offer each other support, and become aware of sup-
porting their own weight, which are very important concepts in partner
dancing. The instructor suggested the students ‘‘allow their weight to fall
into the floor,’’ ‘‘reach their ears toward the ceiling,’’ ‘‘their spine is a
‘‘pearl necklace’’ and thus ‘‘imagine your tail bone is like a heavy amulet
at the end of the pearl necklace and falling to the floor.’’ In a tai-chi
inspired exercise, while standing on two feet, participants would slowly
shift weight from one foot to the other. To target and improve balance,
students were encouraged to release their weight into the floor by
reducing tension in their feet and calves, while concentrating on their
core so their body weight was supported. For some participants, it was
difficult to balance in single leg stance. During the warm up, careful
placement of weight through the feet during weight changes, and
attention to posture were most emphasized.
After warm up, students worked on basic Argentine tango principles,
such as partnership, timing, footwork, and movement quality. Students
learned and practiced compression towards a partner and leveraging
away from the partner through body weight, not through the common
mistake of pushing or pulling with their arms and hands. Because stu-

participation was greatly encouraged and necessary, such as for ‘bicy-
cling’. The students were asked ‘‘Where are we bicycling to, today?’’ which
received responses like ‘next door’, ‘to church’ or ‘along the Great Wall of
China’. Other imagination enhancing exercises were ‘rowing down the
river’ or ‘running a marathon’. ‘Rotating the wrists’ required that each
class period students learn new rhythmic patterns of wrist movement
upon the thighs. Examples from the Exercise Routine Handout follow:
From ‘‘Wand exercises (performed with a yard stick)’’:
a. Swing: Forward and backward, Then in Big circles to R and L.
b. Paddle: What river, lake or stream would you like to paddle down
on your canoe? Imagine your trip. Be sure to take big strokes!
c. Shrug: Arms behind chair with wand.
d. Arm extension: press the wand backwards (arms still behind chair).
e. Finger roll: As fast as you can, then as slow as you can; Rolling out
to the sides of the wand, and back to center. Come up with your
own plan!
From ‘‘Lower Body exercises’’:
f. Bicycle: Where are you going to pedal to? Imagine the trip there
and back.
g. Leg swing: Create your own rhythm.
h. Abs: Try one leg first, then two, then lift higher.
i. Heel toe exercise.
j. Skipping: slow then fast.
k. Scooting: Run a Marathon on your chair. Where would you run that
marathon? Close your eyes and imagine the run.
From ‘‘Upper Body exercises’’:
l. Rotate wrist: come up with your own rhythms.
m. Head, shoulder, knees, toes: you can say this along with the exer-
cise, or sing.
n. Wood: You’re going to make a new piece of furniture for your home.

Control tango 1.03 ± 0.10 1.17 ± 0.14
Control exercise 0.94 ± 0.17 1.01 ± 0.14
Values are means±SD
117Dance for those with Parkinson Disease
ther agree nor disagree, 4 = somewhat disagree, 5 = strongly disagree.)
The balance item stated ‘‘My balance has improved since starting this
program.’’ The Parkinson tango group believed they had experienced
more gains in balance than the Parkinson exercise group (PD tango
mean: 1.78 ± 0.67, PD Exercise mean = 2.89 ± 0.78, independent t-test,
p = 0.005). The control tango and exercise group reversed this trend
(Control Exercise mean = 1.22 ± 0.44, Control Tango = 2.22 ± 1.10, inde-
pendent t-test, p = 0.022). See Table 2 for means and standard errors for
all items on the Exit Questionnaire.
On the One Leg Stance, the Functional reach test, the Falls Efficacy
Scale, and the Activities-specific Balance Confidence Scale, we saw some
improvement in all four measures in the Parkinson tango group.
Regarding the Parkinson exercise group we saw improvement in only
Functional Reach and One Leg Stance while their scores declined on both
the Falls Efficacy Scale and Activities Balance Confidence Scale. The
control exercise group experienced gains only in the One Leg Stance, and
the Activities Balance Confidence Scale, while decreasing in Functional
Reach. The control tango group experienced gains in One Leg Stance,
and remained the same in Functional Reach, and Activities Balance
Confidence (Table 3, Figs. 1 and 2).
Attendance/Participation
All subjects completed the required 20 sessions within 13 weeks. Subjects
who had no or few absences and finished promptly were given the option,
Table 2
Exit Questionnaire
PT PE CT CE

PT PE CT CE
Groups
tniop01noeulavecnedifnoc
e
lacs
pre post
Fig. 1
Falls Efficacy Scale scores for all groups before and after the interven-
tion. Subjects rate on a ten-point scale confidence in their ability not to
fall during daily activities. Higher scores indicate more confidence.
Table 3
Balance measures
Functional Reach (in.) One Leg Stance (s)
Pre Post Pre Post
PD tango 9.6 ± 2.3 10.12 ± 3.6 9.9 ± 10.0 10.3 ± 11.0
PD exercise 8.8 ± 2.6 9.2 ± 3.8 6.9 ± 11.3 8.3 ± 4.4
Control tango 12.5 ± 2.0 12.5 ± 2.5 34.4 ± 24.3 38.6± 25.4
Control exercise 9.2 ± 1.9 8.7 ± 3.0 7.7 ± 9.6 11.1 ± 7.1
119Dance for those with Parkinson Disease
because the music directed and initiated movement, it was so pleasant
and enjoyable.’’ Another wrote ‘‘Without music, why dance?’’ Many ex-
tolled music’s virtue of making exercise become dance.
Fewer participants (15 of 20) in the exercise group felt that music
helped their experience. There were opinions about the type of music
that should be played, whether it should be played, and some people with
PD claimed that it distracted them from the exercise at hand. However,
many claimed that music provided a lighthearted feeling by lifting the
mood, and it tended to make the time pass, and the movements easier to
initiate. They would have preferred to have exercised to the beat of the
music more.

before and after the intervention. The ABC is a 16-item scale that
quantifies percent confidence in balance during activities of daily living.
The maximum score is 100%.
120 M. E. Hackney et al.
only the person with whom they came. But many appreciated dancing
with a new person.
The exercise group stated on the exit questionnaire what they liked
best and least about the program. Again, meeting new people and having
the regular opportunity to socialize and ‘work together’ were appreciated.
They felt the exercises were not boring, and neither did they ‘feel’ like
exercise. The afternoon scheduled time and the drive home were incon-
venient for many, as in the tango group.
The tango group often expressed how important it was that people
with PD and their partners (spouses or caregivers) get together with
others like them because of the supportive and therapeutic aspects. They
requested that they have lunch together at the end of the sessions.
During the dance classes, they were very helpful to one another. Al-
though spouses did not always dance together, all the control subjects
were very considerate of their partners, the individuals with PD. All non-
neurologically challenged individuals who participated as controls in this
study were terrific partners for those with PD. Tango dancing demands
concentration of which the group was quite capable. Since the neuro-
logically challenged were at different stages of the disease, some par-
ticipants were more severely disabled than others, but everyone adjusted
to his or her partner’s capabilities.
The exercise group appeared to enjoy their classes immensely, which
was evident and provable if one could measure their laughter and smiles.
They were very enthusiastic about participating in the imagination and
rhythmic games and seemed quite friendly with one another. It was re-
ported to the instructor that the class members would come early for

revealed to retard mental decline (Cusack and Thompson 1998; Rowe
and Kahn 1998). The progressive nature of the lessons was attractive to
those in the tango group because they learned throughout the class,
perfected motor skills, and used movement in problem solving.
In the traditional exercise class, exercises became repetitious which is
illustrated by this point. During the ‘bicycling’ exercise of the exercise
class, members were invited to tell stories about places they were bicy-
cling to, one of the members would consistently say ‘‘We’re still bicycling,
here!’’ in order to speed up the speaker’s tale. This was always amusing,
but it accentuates the pervasive concept that exercises are ‘‘to be gotten
over with’’, while the progressive nature of tango leads people to wonder
what lies ahead. In the tango class we focused on the movement itself, on
one’s physical connection to one’s partner and on what one’s partner was
doing. In each lesson new steps or concepts were introduced, and all
members knew there was plenty more to learn. In the exercise class, to
make the movement fun we focused on imagined and fantastic scenarios,
rather than on the movement itself.
Argentine tango is a dance done in an embrace or frame, unlike swing
or salsa. This aspect is particularly useful to individuals who are chal-
lenged in terms of balance, because the partner may provide helpful
sensory information and stabilizing support that leads to improved bal-
ance and gait. Argentine tango ‘steps’ are themselves composed of bal-
ance exercises: steps in all directions, placing one foot in front of another
in tandem, rolling through the foot from heel to toe, or toe to heel, leaning
toward or away from a partner, and dynamic balances in single stance.
The tango technique develops focus and attention to task while a dancer
executes the movements, be it turning, stepping, balancing, or a combi-
nation of all three. Among social dances, partnered movement shared
within a social, group setting. Argentine tango allows both participants
122 M. E. Hackney et al.

the instructor and principal investigators their disbelief that people with
PD could dance, but this experience showed them that not only could
they dance, they could learn and improve their dancing abilities similarly
to non-neurologically challenged individuals, and some more so than
healthy elderly. Therefore, PD is not a sentence to restricted activities.
Based on the results from the Philadelphia Geriatric Morale Scale,
these individuals are not only physically challenged. In their tango
classes, some reported feeling like ‘‘themselves again’’, or talked of how
their mood was ‘‘lightened’’. Mood has been demonstrated to impact
health, and the expression of emotion has certain health benefits (Goodill
2005, p. 44). Our members were able to access some of that expression
within themselves during their classes. The effects extended beyond
their class period time, they reported.
123Dance for those with Parkinson Disease
Adherence to an exercise program may be more likely if it is novel and
enjoyable. A study of those at risk of heart failure found that the waltz
was just as good as traditional aerobic exercise and that people were
happier, which was demonstrated by increases in a measure of quality of
life, and greater likeliness to comply with the ‘exercise regime’ (Belard-
inelli et al. 2006). People will feel better if their symptoms improve, but
feeling better certainly has a tendency to improve symptoms. If the self-
reported outcome of DMT treatment on fibromyalgia is considered
appropriate for measuring subjective phenomenon pain (Goodill 2005, p.
92), then this study’s members’ self-reports show extensive benefits for
exercise programs of any kind. However, the novelty, the touch, the
socialization, interaction and the progressive learning aspect of Argen-
tine tango indubitably reveal a highly flexible, appropriate and enjoyable
activity for the healthy elderly and those with PD.
Conclusion
Unquestionably, the results support the idea that exercise in a social

Marian Chace Foundation to Madeleine Hackney and a grant from the
American Parkinson Disease Association to Gammon Earhart.
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